No abstract

ClinicalTrials.gov identifier: NCT01693874.

The authors examined life stress and self-efficacy as predictors of time to relapse for 113 adults with comorbid major depressive disorder and alcohol and/or substance dependence in a randomized clinical trial comparing 2 psychotherapy interventions (integrated cognitive- behavioral therapy and 12-step facilitation therapy). Life stress, self-efficacy, and substance use were assessed at treatment entry, 12 weeks (mid-treatment), and 24 weeks (end of treatment). Time to relapse was defined as the number of days from treatment initiation until first alcohol and/or drug use. Half of the sample relapsed within the study period of 24 weeks. There was no significant difference between treatment groups. Individuals experiencing life stressors were more likely to relapse early than those not experiencing life stressors. Lower self-efficacy also predicted earlier relapse. Chronic stress levels and self-efficacy were stable across time for most individuals. In contrast, acute stress events occurred at differing times, and survival analyses provided evidence of heightened relapse risk in the month following acute stressors. The interaction of self-efficacy and life stress was not significant. The results highlight the significance of life stress and self-efficacy as predictors of early relapse.

The present study compared longitudinal treatment outcomes for depressed substance-dependent veterans (N=206) assigned to Integrated Cognitive Behavioral Therapy plus standard pharmacotherapy (ICBT+P) or Twelve Step Facilitation Therapy plus standard pharmacotherapy (TSF+P). Drug and alcohol involvement and depressive symptomology were measured at intake and at three-month intervals during treatment and up to one year post-treatment. Participants in both treatment conditions showed decreased depression and substance use from intake. ICBT+P participants maintained improvements in substance involvement over time whereas TSF+P participants had more rapid increases in use in the months following treatment. Decreases in depressive symptoms were more pronounced for TSF+P than ICBT+P in the six months post-treatment. Within both treatment groups, higher attendance was associated with improved substance use and depression outcomes over time. Initial levels of depressive symptomology had a complex predictive relationship with long-term depression outcomes. Early treatment response predicted long-term substance use outcomes for a portion of the sample. Although both treatments were associated with improvements in substance use and depression, ICBT+P may lead to more stable substance use reductions compared to TSF+P.

In a randomized trial, this study compared the longitudinal outcome patterns of veterans (N = 66) with substance use disorders and major depressive disorder receiving standard pharmacotherapy and either 12-Step Facilitation Therapy (TSF) or disorder-specific Integrated Cognitive Behavioral Treatment (ICBT). Depression and substance use were assessed at intake, during and after treatment using the Hamilton Depression Rating Scale and the Time Line Follow Back. Reductions in depression during treatment were comparable between the two treatment groups; however, their posttreatment patterns were distinct. While ICBT participants evidenced a steady linear decline in depression through six months posttreatment, a quadratic trend characterized TSF participants, for whom depression declined during treatment, but increased throughout posttreatment follow-up. During treatment, TSF participants used substances less frequently relative to those in ICBT; however, reductions in substance use were more stable through six months posttreatment among those in ICBT relative toTSF. While both interventions produced improvement in depression and substance use during treatment, ICBT may yield more stable clinical outcomes once treatment ceases.

Among a sample of 180 male and 226 female undergraduates, 84.2% reported a heavy drinking episode (5+ drinks for men, 4+ for women) within the previous 90 days. Principal-components analysis revealed 3 alcohol-related problem factors among the heavy drinkers (Careless Behavior, Risky/Reckless Behavior, and Authority Problems). Nearly all heavy drinkers experienced a careless behavior that was due to drinking (92.7%), and many reported a risky/reckless behavior (60.2%), yet only one third (33.9%) experienced an authority problem. Guttman scaling procedures revealed a progression from Careless Behavior to Reckless/Risky Behavior to an Authority Problem. Heavy drinkers with an authority problem drank more frequently, consumed more when drinking, endorsed more alcohol expectancies, and reported earlier ages of initial and regular drinking than other groups.

No abstract

The relative impact of biological family history of alcoholism and exposure to abusive parental drinking on alcohol effect expectancies of adolescent offspring were investigated in the present study. Exposure to familial models of alcohol abuse and biological family history were both predictive of positive alcohol effect expectancies of adolescent offspring. Degree of exposure to an alcohol-abusing family member mediated the relationship between biological family history of alcoholism and adolescent alcohol outcome expectancies. These results support prior findings of expectancy differences between youths with and without a family background of alcoholism and provide evidence supporting the significance of family modeling influences in the development of adolescents' alcohol expectancies.